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What Top Doctors Can Teach Educators

The ever-impressive Atul Gawandesurgeon, New Yorker contributor, and public health researcherhas provided plenty of blog fodder for us here at Teacher over the last few months. And his keynote address at the 2012 ASCD Conference on Sunday was no exception.

Gawande began by explaining why he'd been chosen for the address. "We have something really fundamental in common. As doctors and teachers, we are both privy to the secrets of people' lives," he said.

When he began writing about his work as a doctor, he said, he became more and more intrigued by the question of "how we all get good at what we do, and the difference between those who are merely competent and those who are great." One of the greatest challenges for those working in helping professions is recognize that their efficacy varies widely. "There is a bell curve, a wide gap between the best [and worst] results," he said. "Most of us are grouped in the mediocre middle."

To explore this gap, Gawande said he decided to research the bell curve within the treatment of cystic fibrosisa genetic disease with an average survival of 34 years. At the top of the curvein the best treatment facilitiesthe average survival is 47 years or longer. "I don't want to tell you what it's like at the other end of the curve," Gawande said.

He visited a hospital that receives some of the most severely stricken cystic fibrosis patients and yet is at the top of the curvethe University of Minnesota Medical Center at Fairview. Gawande shadowed the director of the cystic fibrosis program there, Dr. Warren Warwick, and watched as he checked in with a 17-year-old patient whose health had diminished over the last three months. With curiosity, not judgment, the doctor asked the girl a series of detailed questions about what was going on in her life. The girl finally admitted she had a new job, a new boyfriend, and had completely gone off her treatment. Warwick turned to Gawande and said, "You see, cystic fibrosis patients are interesting patients because they are good scientists."

Dr. Warkwick then put on his teaching hat and worked out some numbers for the girl. He explained that if she didn't take her medicine on any given day, she had a .5 percent chance of getting a lung infection. If she did take her medication the risk was .05 percent. While she was almost 100 percent sure to be well on any given day even if she didn't take her medicine, her chance of making it through an entire year without a bad infection was 17 percent. If she took the medicine, the chance went up to 83 percent.

The doctor then helped the teenager unpack the reasons she was not taking her medicine, and the two came up with a plan to overcome each of those obstacles. He even went so far as to call the patient's best friend to tell her the plan and enlist her help.
According to Gawande, three traits in particular make that doctorand the others at his hospitalgreat at what he does: diligence, recognition of failure, and attention to detail.

"Excellence is not the difference between bad and good," he said. "It's the difference between good and great. It's the difference everyday between 99.5 percent success and 99.95 percent success."

Gawande went on to discuss the need for coaching and collaborative teamwork, both of which have even more overt applications to both teaching and medicine. But, as I see it, educators could find enough lessons in just in that one story alone for a school year's worth of PD.

What are your thoughts? What can educators learn from how Warwick treats cystic fibrosis patients? How can teachers use similar methods as Warwick? And on the flip side, is there any danger in substituting value-added scores for cystic fibrosis survival rates? With the medical model in mind, how can we determine which teachers are at the top of the bell curve?

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